Integrating Outcome Transparency via Internal Benchmarking with Process Redesign Initiatives in Surgical Departments: A Retrospective Observational Study Across Eight Austrian Hospitals

Background: Internal benchmarking is a key instrument for measuring surgical outcomes and supporting continuous quality improvement (CQI). The LeistungsVergleich Medizin (LeiVMed) platform has enabled systematic outcome monitoring across eight Austrian hospitals since 2015. Between 2015 and 2019, clinical pathways and CQI initiatives were implemented but discontinued during the COVID-19 pandemic.

Methods: This retrospective study analyzed complication trends in cholecystectomy and herniotomy patients across two periods: 2015–2019 and 2020–2023. Data on patient characteristics, risk factors, procedures, length of stay, and outcomes were collected via hospital databases and validated complication reviews. Logistic regression was used to identify factors associated with postoperative complications.

Results: Mean complication rates increased from 5.8% in 2015–2019 to 7.7% in 2020–2023. Lower complication rates were significantly associated with the earlier period, lower ASA class, elective admission, fewer preoperative risk factors, and younger age. Significant differences were also observed between surgical departments.

Conclusion: Periods combining internal benchmarking with clinical pathways and CQI measures were associated with significantly lower complication rates. These findings suggest that integrating outcome transparency with structured process redesign may be an effective strategy to improve surgical outcomes.